| NPI | 1972367076 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMMY ELIZABETH JACKSON Owner 502-385-0806 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2024-02-08 |
| Last Update Date | 2025-01-27 |